92 Decision Citation: BVA 92-08672
Y92
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 91-45 922 ) DATE
)
)
)
THE ISSUES
1. Entitlement to an increased (compensable) evaluation for
a pilonidal cyst.
2. Entitlement to service connection for chronic residuals
of a coccyx injury.
REPRESENTATION
Appellant represented by: Paralyzed Veterans of America,
Inc.
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
J. Stachewicz, Associate Counsel
INTRODUCTION
The veteran had active military service from March 1981 to
March 1985.
This matter came before the Board of Veterans' Appeals
(hereinafter the Board) on appeal from a rating decision of
the Wichita, Kansas, VA Regional Office (hereinafter the
RO). The procedural development in this case was as follows:
a RO rating decision, dated in July 1990, granted the
appellant service connection for postoperative residuals of
a pilonidal cyst (0%), and denied her claim to entitlement
to service connection for an eye condition, residuals of a
right thumb injury and residuals of a coccyx injury; in
August 1990, the RO received the appellant's notice of
disagreement; in November 1990 the RO issued a statement of
the case; in February 1991 the RO received the appellant's
substantive appeal; in March 1991 the appellant testified
before an official of the RO concerning the issues set forth
on the title page, and she specifically withdrew from
appellate consideration the issues of service connection for
a chronic eye condition and residuals of a right thumb
injury; in May 1991 the RO issued a supplemental statement
of the case; in October 1991 the case was docketed at the
Board. In October 1991, the appellant's designated
representative, the Paralyzed Veterans of America,
Inc.(hereinafter PVA), filed written argument with the Board.
CONTENTIONS OF APPELLANT ON APPEAL
It is contended by the appellant that the RO committed error
in denying her claim for an increased (compensable) evalua-
tion for a pilonidal cyst. Furthermore, the appellant
asserts the RO committed error by denying service connection
for residuals of a coccyx injury.
DECISION OF THE BOARD
For the reasons and bases hereinafter set forth, it is the
decision of the Board that the preponderance of the evidence
is against the appellant's claims for an increased (compens-
able) evaluation for a pilonidal cyst and service connection
for residuals of a coccyx injury.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the instant appeal has been obtained by the
RO.
2. Pilonidal cyst is well healed with no clinically
objective deformity.
3. It is not shown that the veteran has chronic residuals of
a coccyx injury sustained during service.
CONCLUSIONS OF LAW
1. The applicable criteria for an increased (compensable)
evaluation for postoperative residuals of a pilonidal cyst
have not been met. 38 U.S.C. § 1155; 38 C.F.R. Part 4,
Codes 7803-7805.
2. Chronic residuals of a coccyx injury were not incurred in
active military service. 38 U.S.C. § 1131.
REASONS AND BASES FOR FINDINGS AND CONCLUSIONS
Where the veteran submits a facially valid claim, the VA is
obligated to assist her in developing facts pertinent to the
claim. See Gilbert v. Derwinski, U.S. Vet. App. 89-53
(Oct. 12, 1990). As an initial matter, we find the
appellant's claims are "well grounded," within the meaning
of 38 U.S.C. § 5107(a), since the claims are not inherently
implausible.
The Board finds the appellate record is adequate, and that
the VA is not obligated to assist the appellant further in
order to develop facts pertinent to her claim. See Littke
v. Derwinski, U.S. Vet. App. 90-107 (Nov. 8, 1990).
I. Pilonidal Cyst
Disability evaluations are determined by the application of
a schedule of ratings which is based on average impairment.
38 U.S.C. § 1155; 38 C.F.R. Part 4. Separated diagnostic
codes identify the various disabilities. Id.
The law provides a 10 percent evaluation for residuals of a
pilonidal cyst where the scars are poorly nourished, with
repeated ulceration; are tender and painful on objective
demonstration; or are productive of limitation of function
of the body part which they affect. 38 C.F.R. Part 4, Codes
7803, 7804, and 7805.
The evidence of record includes a private medical report,
dated in September 1989, from the Hillside Medical Office
that shows the appellant had an abscess described as a "cyst
on the tailbone" for the past 3 to 4 days. The examiner
observed a erythema, with some fluctuance present just
lateral to midline of her left buttocks at the coccygeal
level. The cyst was incised and drained. Reportedly, the
examination was otherwise unremarkable.
A March 1990 VA examination report indicates the appellant
had a healed 4 cm. scar in the coccyx area. It was reported
that there was a very small pinhead sized "oriphis" in the
scar. No redness or drainage was present, the examiner
noted.
A written statement, dated in March 1991, by Steven D.
Penner, M.D., indicates the appellant has had difficulty
with a small pilonidal cyst, left of mid-line, at the
coccygeal level. Reportedly, the cyst was drained in
September 1989. Reportedly, he prescribed an antibiotic for
the appellant in August 1990, at which time no definitive
surgery was required.
In March 1991 the appellant testified that her pilonidal
cyst becomes painful after prolonged periods of sitting.
See hearing transcript, hereinafter T., at 2. However, at
the time of the hearing, the appellant testified that the
cyst was asymptomatic (i.e. no drainage, itching, swelling,
or pain). T. at 6.
A VA examination report, dated in April 1991, shows the
appellant complained of pain in the tail bone, the area of
the cyst. The examiner noted that the appellant had a
2-inch, well-healed scar at the end of the lumbar area,
apparently from the previous incision and drainage of the
pilonidal cyst. The examiner noted that the cyst was not
palpable, and no tenderness in the coccyx area was observed.
Reportedly, there was no clinical evidence of a pilonidal
cyst. The appellant stated that when the sinus became
infected it became a "little tender." The examiner's
diagnosis was pilonidal cyst, by history, with history of
being drained twice.
The Board finds the latest VA examination report, and the
appellant's testimony, to have significant probative value.
Under the governing legal criteria, cited herein, a compens-
able evaluation is not shown to be warranted.
The Board notes that consideration has been given to the
potential application of the various provisions of 38 C.F.R.
Parts 3 and 4, whether or not they were raised by the
appellant, as required by Schafrath v. Derwinski, U.S. Vet.
App. No. 89-114 (Nov. 26, 1991).
II. Chronic Residuals of Coccyx Injury
In order to be entitled to service connection for chronic
residuals of a coccyx injury, it must be shown that they
resulted from injury incurred during service. 38 U.S.C.
§ 1131.
In this case, the appellant's service medical records may be
briefly summarized: The report of the appellant's physical
examination for purposes of entrance onto active duty, dated
in January 1981, shows no pertinent abnormality. A service
medical report, dated in January 1984, shows the appellant
complained of pain in the coccyx area lasting several days.
The medical examiner determined that the pain was caused by
a pilonidal abscess. A clinical history of trauma was not
mentioned by the veteran on that occasion. The examiner's
impression was a pilonidal cyst abscess which required
incision and drainage.
Post service medical records include a March 1990 VA
examination report that indicates the appellant's coccyx was
normal with no visible deformity or swelling. X-ray examina-
tion of the appellant's coccyx, accomplished in February
1990, shows the fifth segment of the sacrum displayed a
moderate forward tilt in relationship to the fourth. The
examiner noted that this may be a congenital anomaly or it
could be on the basis of an old healed fracture.
The appellant testified that she slipped and fell off an F4
aircraft during service and landed on her tailbone. See T.
at 7. A written statement submitted to the RO by the
appellant's father, dated in March 1991, relates that while
his daughter was stationed in the Philippines she called him
on the telephone and informed him that she fell from a plane
and landed on her tailbone.
In this case, the lay statement from the appellant's father
provides a restatement of her testimony that she fell and
hurt her tailbone during service. Such is considered to be
of minimal probative value. The same can be said of the
appellant's testimony because it is not substantiated by
documentation in the service medical records that any coccyx
injury was sustained in service. When viewing this evidence
in the context of the appellant's service medical records
and post service private medical records, the Board finds
that the weight of the evidence is against the appellant.
The appellant's service medical records are completely
negative for any complaint, manifestation or diagnosis
relating to a coccyx injury. At the time she sought medical
treatment for pain relative to her coccyx area in service
she expressed no clinical history of trauma. While it has
been argued recently that this failure to mention the trauma
grew out of her fear of a reprimand for carelessness, we do
not understand how such a history of trauma, if it actually
occurred, could be kept from a clinician when medical
treatment was subsequently sought. Obviously, no adverse
ramifications would ensue by informing the treating health
care provider of such vital information. On the contrary,
withholding such information contemporaneous with the injury
could impact negatively on the care provided. Thus, the
absence of such clinical history of trauma in service is of
substantial probative value.
While the X-ray evidence obtained almost five years post
service separation is equivocal as to whether the tilt of
the sacrum is due to a congenital anomaly or an old,
well-healed fracture, the fact of the matter is that there
is no contemporaneous corroboration for the appellant's
assertion that she sustained coccyx trauma in service.
ORDER
Increased (compensable) evaluation for residuals of a
pilonidal cyst is denied.
Service connection for the chronic residuals of a coccyx
injury is denied.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
STEPHEN A. JONES L. W. TOBIN
J. F. GOUGH
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C. § 7266 (1991),
a decision of the Board of Veterans' Appeals granting less
than the complete benefit, or benefits, sought on appeal is
appealable to the United States Court of Veterans Appeals
within 120 days from the date of mailing of notice of the
decision, provided that a Notice of Disagreement concerning
an issue which was before the Board was filed with the
agency of original jurisdiction on or after November 18,
1988. Veterans' Judicial Review Act, Pub. L. No. 100-687,
§ 402 (1988). The date which appears on the face of this
decision constitutes the date of mailing and the copy of
this decision which you have received is your notice of the
action taken on your appeal by the Board of Veterans'
Appeals.